Who decides if a dying patient can ask their doctor to help them to a humane and peaceful death? Today Compassion & Choices as well as our opponents on the other side of this question recognize the stars are aligned to make it an emerging focal point in the struggle for liberty.

Why this question? Why now? Because new technology, cultural and economic shifts and rising expectations create needs and opportunities in the development of any social movement. Sometimes dramatic events precipitate a change. Fifty years ago death came with speed and certainty. Today it more often drags its victims down in a long, agonized process of decreased function and increased suffering.

Fighting for their country in World War II, many black Americans experienced acceptance and responsibility in the military they lacked at home. At the same time the spread of agricultural mechanization offered fewer jobs for those without a high school education. Businesses found racial intolerance made their companies less attractive as investments. Conditions were ripe to consider the question: Who decides if race defines opportunities? When Rosa Parks refused to relinquish her seat on a Montgomery bus she helped ignite the movement that brought desegregation.

Who decides if married couples may use birth control? For years, state legislatures decided, the Catholic Church supported them and few questioned those authorities. But conditions changed. Women who held jobs during World War II were expected to return to domestic pursuits after its close, but in the 1950’s a rising number wanted to hold successful careers and achieve equality.

Economic, cultural and technological changes empowered women to push for reproductive choice, and in 1965 the U.S. Supreme Court decided Griswold v. Connecticut, finding that a state’s ban on contraceptives violated the right to marital privacy. To some, a woman in control of her own fertility threatened family and society. Reproductive choice made a lot of people very uncomfortable. Pushing past that discomfort, the majority of Americans came to recognize the right of couples themselves to decide on intimate, personal matters free from government intrusion.

Today, a new medical reality defines the border of acceptable autonomy. Remarkable advances in medical technology have prolonged the dying process and spurred questions about how and where we die. Gradually, a cultural shift is making discussions of death more acceptable in America. The demographic leviathan of the Baby Boomer Generation, whose attention was once on reproduction, increasingly confronts issues around their mortality. And in 2005, when Michael Schiavo asked who decides if his wife Terri should be allowed to die with dignity, Americans recoiled in horror as politicians tried to establish their right to override state courts and make end-of-life decisions.

The newest star in the constellation of autonomy and personal freedom emerges at the edge of life. Its light will shine fully when we establish the right of all terminally ill, mentally competent adults to control their last days. Securing the liberty to access medication one may choose to ingest to achieve a peaceful death establishes the over-riding principle that end-of-life decisions reside with patients themselves, not doctors, not politicians and not the government or religious leaders.

Local and national politicians may be uncomfortable publicly supporting this principle, but that’s expected. Social movements gain strength from the recognition that established powers are incapable of adapting to changing social needs and expectations.

Discomfort alone should not control laws. A 1986 Supreme Court case, Bowers v. Hardwick, upheld Georgia law against certain sex acts between consenting and loving adults. Justice Harry Blackmun dissented, citing “the rights of those whose choices upset the majority.” He wrote, “No matter how uncomfortable a certain group may make the majority of this Court, we have held that ‘[m]ere public intolerance or animosity cannot constitutionally justify the deprivation of a person’s physical liberty.'” In 2003, Justice Blackmun’s logic prevailed, and Bowers v. Hardwick became obsolete.

Compassion & Choices serves people facing death and protects their choices: to accept offered treatment or not; to focus treatment primarily on the quantity of life or its quality; to die at home, in hospice or at the hospital. In Oregon, Washington and Montana they also have the legal choice – and only a small minority access it – to ask their doctor for medication to bring about a peaceful death. The next great human liberty battle is to establish the right of every American to exercise such choices, the intimate, personal end-of-life choices that seem to make so many people uncomfortable.

Who decides if a dying patient can ask their doctor to help them to a humane and peaceful death? As never before, that is a question that galvanizes American opinion. That is the question emerging as the brightest star on society’s horizon. Compassion and Choices works not only for those facing the end of life, but for all those who chart the path of social progress by the constellation of human liberty.